Rapid CommunicationProspective determination of the hormonal response after cessation of luteinizing hormone-releasing hormone agonist treatment in patients with prostate cancer
Section snippets
Patients
Between April 1997 and September 1997, 14 patients actively followed up in our urology clinic were enrolled in a prospective pilot study. The study was approved by the University of Texas Southwestern Medical Center at Dallas Institutional Review Board. Patients with histologic confirmation of prostate cancer, locally advanced (T3 to T4) or metastatic (M1) disease, no evidence of clinical or biochemical progression, and who received LHRH agonist treatment for a minimum of 2 years were eligible.
Results
The mean age of patients enrolled was 70.3 years (range 56 to 84). At entry, patients had received LHRH agonist for a mean of 38.6 months (range 25 to 82). The results of serum determination of PSA, testosterone, and LH at baseline and at follow-up during the study are summarized in Table I. All patients had castrate levels of testosterone (median 10.0 ng/dL) and suppressed LH levels (median 0.1 mIU/mL) at baseline.
On multiple groupwise comparison (ANOVA), there was no significant change
Comment
LHRH agonists are a widely accepted alternative to orchiectomy or estrogen therapy in patients with prostate cancer. Although clearly shown in randomized comparative trials to reliably produce and maintain castrate levels of testosterone with repeated dosing, there is little information concerning the duration of effect after drug cessation. Reversibility with recovery of a normally functioning hypothalamic-pituitary-testicular axis is especially pertinent when these agents are used in the
Conclusions
The recovery of hypothalamic-pituitary-testosterone axis function after prolonged administration of LHRH agonist is variable in terms of extent and time-course. In a significant subset of patients, castrate levels of testosterone and LH suppression persist long after discontinuing therapy. These observations have significant implications, including economic aspects of dosage schedule and the interpretation of clinical trials incorporating neoadjuvant and adjuvant LHRH therapy. Further studies
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2015, UrologyCitation Excerpt :Few authors studied the time-course of plasma testosterone after stopping treatment on patients with androgen deprivation therapy extended for more than 6 months. Hall's group analyzed plasma testosterone's kinetic on 14 patients treated for more than 2 years with luteinizing hormone-releasing hormone (LH-RH) agonist therapy for advanced prostate cancer, and on whom hormonotherapy was stopped.20 When hormonotherapy was stopped, all patients had effective castration levels.
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2014, European UrologyCitation Excerpt :Most doses were for 3- or 4-mo equivalent doses. Because hypogonadism may persist for prolonged periods after GnRH agonist discontinuation [21], men were considered continuously treated for 6 mo after each dose of GnRH agonist. We characterized each man's age at diagnosis, race, Hispanic ethnicity, marital status, year of diagnosis, tumor grade and size, type of primary treatment (surgery, radiation, or neither) [22], SEER region, urban residence, census-tract level income, and education (categorized in quartiles within registries).
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2013, European UrologyCitation Excerpt :We used administrative data, including gonadotropin-releasing hormone (GnRH) agonists and bilateral orchiectomy (Appendix), to ascertain ADT receipt. Because most doses were 3- or 4-mo doses and since men may have persistent hypogonadism for prolonged periods after GnRH agonist discontinuation [16,17], men were considered continuously treated for 6 mo after each GnRH agonist dose. We characterized each man's age at diagnosis.
Prostate Cancer Management: What Does the Future Hold?
2010, European Urology, SupplementsCitation Excerpt :The TTR mostly depends on the age of the patient and on the duration of ADT [13,14]. Testosterone recovery may be achieved in 73–100% of patients within 6 mo of stopping ADT that lasts for ≤1 yr, whereas it may be as low as 0–18% at 6 mo in patients who have received ADT for 3 yr [9,10,14,15]. The period of attenuated serum testosterone concentrations in most patients who have received ADT for 3 yr is approximately 18 mo [10,15,16].
Prolonged hypogonadism after cessation of androgen deprivation therapy for prostate cancer
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Dr. Hall is currently at the Department of Urology and Comprehensive Cancer Center, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157.